When we look at what the right-to-die movement has achieved, against what it has wished to do, an honest person would agree that there is still a long, long way to go.

The first signs of organized activity on this issue came in the late 1930s in Britain, but nothing really happened until the l970s when the public  the non-medical world  woke up with a shock to the fact that we often die differently nowadays compared to our ancestors.

This revelation  first made famous and characterized by the Karen Ann Quinlan pull-the-plug case in America  brought a rush of legislation introducing the so-called Living Wills  better known nowadays as Advance Directives, permitting the disconnection  or declining the use of  pointless life support equipment.

Today Advance Directives are available pretty well everywhere. That fight has largely been won, although the problem remains in getting people to appreciate their significance and sign them early enough before terminal ill health appears.

As this conference's information shows, Living Wills continually need to be improved to keep pace with medical advances and updated by the signators, even young people.

Where we have even further  much further  to go is related to active voluntary euthanasia and assisted suicide for the terminally ill adult, and the hopelessly ill person.

So far only the Netherlands and Belgium legally allow the first and second procedures, whilst Switzerland and Oregon (USA) allow assisted suicide. All the procedures mentioned here have strong rules and guidelines to prevent abuse.

Actually helping people who desire a hastened death so as to avoid further suffering has a long fight ahead of it. There is stiff opposition. The underlying taboo in social life and the opposition of religious leaders in the rest of the Western world is holding back progress despite the knowledge that at a minimum  judging by electoral votes and opinion polls  fifty percent of the general public wishes to see reform to give them an eventual certain death with dignity. Other opinion testings shows 70 to 80 percent support for law reform.

The main problem is: how do we convert the converted into actual voters? The experience in America, probably the only place where actual citizens have on six occasions been ask to ballot for a right-to-die law, there are early indications that law reform will pass. Then, as the voters get to place their YEA or NAY on the ballot paper, many appear to have doubts. Except for the successful polls in Oregon in l994 and l996, the ballot initiatives have all failed.

Why is that? Many excuses have been offered, but my conclusion is that because we are not yet carrying a majority of the medical and nursing professions in support of us, the public  understandably  panics. Who amongst us is brave enough to defy our personal medical advisors?

Of course, not all doctors and nurses will ever support us. They are entitled to have religious and ethical differences. Yet only when we have a majority of them on our side  and saying so publicly  can be assured that future law reform will succeed.

What must we do to bring more of the healing professions and their clients around to our way of thinking?

We have to change the climate of thinking in respect of individual choices in dying. We have to modify social changes ourselves. Others have done it in universal suffrage, birth control, marriage and divorces, abortion rights, and so on. Here is what I think we must do to start with:

First, be right there on the front line, at the bedside, for dying people who seek our help. Help comes in many different ways, from straightforward advice (which is my speciality), skilled counseling, and supervision of the justifiable suicide of a person who is dying, has fought all they could, and wants a careful release from this world.

The Dutch pioneered this at the home approach from the l970s onwards, and also the Swiss groups have admirable set-ups. Non-doctor assisted suicide is often the appropriate action in certain cases. On the West Coast of America, Compassion in Dying successful launched this type of personal compassion in the early 1900s, and Hemlock's Caring Friends began similar work in l999.

This kind of careful assistance, which comes in a multitude of ways depending on the patients circumstances, is the most important way to build widespread voter confidence and trust. It takes time and effort but not only is it worth it to be responding to another humans cry for help, it earns admiration from a widening circle.

Secondly, if we are to eliminate the taboos and fears of abuse that some people have, we must make the subject of hastened death, assisted suicide, voluntary euthanasia  call it what you like  then we must get better integrated into our cultures.

For too long, the Judeo-Christian religions have dominated ethical thinking in the West. I am not learned enough to be sure, but it seems the same position obtainsin the Buddhist, Muslim, Hindu, and other religions.

Our goals will only be achieved when there is more written about the subject in an investigative and compassionate way. We need to work for the day when the modern news media will report right-to-die matters in a straightforward way and not wait for the scandal and disgrace incidents which they most love to report.

In sum, we must introduce our subject more healthily into literature, media and the arts so that is as commonplace to read, watch, or listen to, in our lives as watching sporting events or monitoring political news.

At least we cannot blame Hollywood, the movie industry, for ignoring us. In the last few years there have been four major movies dealing with rational suicide, and all were appropriate and tasteful.

Trouble is, they may run out of material unless concerned new writers emerge.

Thirdly, we need a few ordinary physicians in different countries to become involved in criminal proceedings: to be the guinea pigs and the cause celebres. If politicians are nervous about our goals, then we should use the courts. But you cannot go to the courts without a defendant willing to take the heat and strain of a high-profile trial. Such martyrs are a rarity.

We need a few doctors who will stand up and say: My patient was suffering unbearably as he was dying. My patient was rational. I assisted a death on request. I will fight in the courts for my duty to help a patient.

Dr. Jack Kevorkian thought he was the man to shake the American medical profession into changing its attitude on euthanasia. But he failed, and some say did harm to the cause but other disagree. His public relations problems in respect to enhancing the attitudes to euthanasia were that he was a pathologist and not a general practitioner, and more of a showman than a missionary. More of a media circus performer than a dedicated campaigner. A loner not a team player. He alone thought he could alter the attitudes of the huge American medical profession. He underestimated the respect doctors have for the law of the land. Without law reform accompanying it, they would not take the same chances which he would.

Dr. Kevorkian's final objective was right but his tactics proved to be wrong. But I give Kevorkian the credit for awakening millions of slumbering people to the very existence of assisted deaths.

Today he languishes in an American prison, convicted on his own evidence of murder, serving ten years to life. At 76 he may never see liberty again. For all his courage and unswerving dedication he has paid dearly. His legal advisors are now seeking a clemency deal, and I really hope they succeed. The predicament in thinking about Dr. Kevorkian is that, while legally he was 100 percent guilty of euthanizing Thomas Youk, who was dying, because he video-taped it, is that 'murder' in the usual sense of the term?

Unfortunately, Anglo-American law makes no distinction on these grounds: A person cannot ask to be killed. We must get this modified.

My plea is for the laws on homicide to be changed to allow somebody accused of a mercy killing to at least plead justification and necessity. Not an automatic, knee-jerk excuse but a factual plea for understanding of the circumstances. Currently no such evidence or witness can be entertained. In my view we should work for a wider interpretation of the laws on death and dying and not just assisted suicide.

In closing my remarks, please allow me to make a plea for more honest use of words and phrases throughout our movement. In recent years there has been a obvious backing away from words like euthanasia and assisted suicide and mercy killing. I am quite aware that this was done for political correctness, trying not to scare off the politicians
and the voters.

But not calling a spade a spade  as the English say  is playing into the hands of our opponents, who increasingly are teasing us that we are more sinister than we say we are. Speaking in euphemisms  softened speech  develops into muddled thinking and mistaken actions.

I hope we all here are  as I am  fighting for the ultimate civil liberty, the right to choose to die when we wish and how we wish, no matter what it is called. Thank you for listening.

Derek Humphry
derekhumphry@starband.net

Speech By Derek Humphry at the 15th World Conference, Tokyo 2004 (September 2004).

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Formerly a London Sunday Times reporter, Derek Humphry founded the Hemlock Society USA in l980 and the Euthanasia Research & Guidance Organization in l993. Derek is editor of the World Right-to-Die Newsletter and advisor to the Final Exit Network. He is the author of six books on euthanasia, the best-known one being Final Exit which has been continuously in print for 12 years. He lives in Oregon.

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